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Why Wear Face Masks in Public? Here’s What the Research Shows

Health + Wellness
Why Wear Face Masks in Public? Here’s What the Research Shows
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By Hector Chapa

With the coronavirus pandemic quickly spreading, U.S. health officials have changed their advice on face masks and now recommend people wear cloth masks in public areas where social distancing can be difficult, such as grocery stores.

But can these masks be effective?


President Donald Trump, in announcing the change in the Centers for Disease Control and Prevention's guidance on April 3, stressed that the recommendation was voluntary and said he probably wouldn't follow it. Governors and mayors, however, have started encouraging the precautions to reduce the spread of the virus by people who might not know they are infected.

Some cities have gone as far as setting fines for failing to wear a mask. In Laredo, Texas, anyone over the age of five who walks into a store or takes public transit without their mouth and nose covered by a mask or bandana could now be fined up to $1,000.

These new measures are designed to "flatten the curve," or slow the spread of the coronavirus responsible for COVID-19.

They're also a shift from the advice Americans have been hearing since the coronavirus pandemic began.

The World Health Organization and the CDC have repeatedly said that most people do not need to wear masks unless they are sick and coughing. In February, the U.S. surgeon general even urged the public to stop buying medical masks, warning that it would not help against the spread of the coronavirus. Part of the reason was to reserve N95 respirators and masks for healthcare workers like myself who are on the front lines and exposed to people with COVID-19.

Today, there is much more data and evidence on how COVID-19 is spread, and the prevalence of the disease itself is far more widespread than previously thought.

Sick, but No Symptoms

As recently as early February, the World Health Organization stated that viral transmission from asymptomatic people was likely "rare," based on information available at the time. But a growing body of data now suggests that a significant number of infected people who don't have symptoms can still transmit the virus to others.

A CDC report issued March 23 on COVID-19 outbreaks on cruise ships offers a glimpse of the danger. It describes how the testing of passengers and crew on board the Diamond Princess found that nearly half — 46.5 percent — of the more than 700 people found to be infected with the new coronavirus had no symptoms at the time of testing.

The CDC explained that "a high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew."

Dr. Harvey Fineberg, former president of the National Academy of Medicine and head of a new federal committee on infectious diseases, told CNN on April 2 that he will start wearing a mask in public, especially at grocery stores, for this very reason. "While the current specific research is limited, the results of available studies are consistent with aerosolization of virus from normal breathing," he said.

It is these "silent carriers" — people infected with the virus but without fever, cough, or muscle aches — that proponents of universal mask wearing point to as proof that more could be done beyond social distancing to slow the virus's spread.

More Effective Than Doing Nothing

While research on the effectiveness of universal mask wearing for reducing respiratory droplet transmission is still thin, there is evidence to support it.

Research on SARS, another coronavirus, found that N95 masks were highly effective at blocking transmission of that virus. Even ill-fitting medical face masks have been found to interrupt airborne particles and viruses, keeping them from reaching as far when someone sneezes.

Another study determined that, while masks made out of cotton T-shirts were far less effective than manufactured surgical masks in preventing wearers from expelling droplets, they did reduce droplets and were better than no protection at all.

A Challenge With Cloth: Washing

The surgical masks that doctors and nurses typically wear are designed for one-time use, while cloth masks used by the general public would likely be washed, which raises another concern.

A study from Nepal on cloth masks designed to protect wearers from larger particles, such as pollution or pollen, found that washing and drying practices deteriorated the mask's efficiency because they damaged the cloth material.

It is clear that urgent research is needed on the best material suitable for universal masks, their storage and care, or the creation of proper reusable masks for the public.

A Low-Risk Intervention

As an obstetrician-gynecologist and researcher, I believe that some protection for the public is better than none. A recent article in the medical journal The Lancet Respiratory Medicine states a similar rationale.

The universal use of mouth and nose covering with masks is a low-risk intervention that can only assist in reducing the spread of this terrible illness. If everyone wears a mask, individuals protect one another, reducing overall community transmission. It could even remind people not to touch their faces after touching potentially contaminated surfaces.

As the research shows, masks aren't shields. It's still important to help prevent transmission by practicing social distancing by staying at least 6 feet away from others in public, staying home as much as possible, and washing hands frequently and properly.

Reposted with permission from The Conversation.

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In early October, Britain's Prince William teamed up with conservationist David Attenborough to launch the Earthshot Prize, a new award for environmentalist innovation. The Earthshot brands itself the "most prestigious global environment prize in history."

The world-famous wildlife broadcaster and his royal sidekick appear to have played an active role in the prize's inception, and media coverage has focused largely on them as the faces of the campaign.

But the pair are only the frontmen of a much larger movement which has been in development for several years. In addition to a panel of experts who will decide on the winners, the prize's formation took advice from the World Wildlife Fund, Greenpeace and the Jack Ma Foundation.

With more and more global attention on the climate crisis, celebrity endorsement of environmental causes has become more common. But why do environmental causes recruit famous faces for their campaigns? And what difference can it make?

'Count Me In'

"We need celebrities to reach those people who we cannot reach ourselves," says Sarah Marchildon from the United Nations Climate Change secretariat (UNFCCC) in Bonn, Germany.

Marchildon is a proponent of the use of celebrities to raise awareness of environmental causes. In addition to promoting a selection of climate ambassadors who represent the UN on sustainability issues, Marchildon's team has produced videos with well-known narrators from the entertainment world: among them, Morgan Freeman and Mark Ruffalo.

"We choose celebrities who have a lifestyle where they are already talking about these issues," Marchildon explains.

"Sometimes they reach out to us themselves, as David Attenborough did recently. And then they can promote the videos on their own social channels which reach more people than we do — for example, if they have 20 million followers and we have 750,000."

Environmental groups focused on their own domestic markets are also taking this approach. One Germany-based organization that uses celebrities in campaigns is the German Zero NGO. Set up in 2019, it advocates for a climate-neutral Germany by 2035.

German Zero produced a video in March 2020 introducing the campaign with "66 celebrities" that supported the campaign, among them Deutschland 83 actor Jonas Nay and former professional footballer Andre Schürrle. They solicit support as well as financial contributions from viewers.

"Count me in," they say, pointing toward the camera. "You too?"

"We are incredibly grateful for the VIPs in our videos," says German Zero spokeswoman Eva-Maria McCormack.

Assessing Success Is Complex

But quantifying the effectiveness of celebrity endorsement of campaigns is not a straightforward process.

"In order to measure effectiveness, first of all you need to define what is meant by success," says Alegria Olmedo, a researcher at the Zoology Department at the University of Oxford.

Olmedo is the author of a study looking at a range of campaigns concerning pangolin consumption, fronted by local and Western celebrities, in Vietnam and China. But she says her biggest stumbling block was knowing how to measure a campaign's success.

"You need a clear theory of change," explains Olmedo. "Have the celebrities actually helped in achieving the campaign's goals? And how do you quantify these goals? Maybe it is increased donations or higher engagement with a cause."

A popular campaign in China in recent years saw famous chefs Zhao Danian and Shu Yi pledge to abstain from cooking endangered wildlife. While the pledge achieved widespread recognition, both Olmedo and Marchildon say it's difficult to know whether it made any difference to people's actions.

"In life we see a thousand messages every day, and it is very hard to pinpoint whether one campaign has actually made a difference in people's behavior," she explains.

Awareness Is Not Enough

Many campaigns that feature celebrities focus on raising awareness rather than on concrete action — which, for researcher Olmedo, raises a further problem in identifying effectiveness.

"Reach should never be a success outcome," she says. "Many campaigns say they reached a certain number of people on social media. But there has been a lot of research that shows that simply giving people information does not mean they are actually going to remember it or act upon it."

But anecdotal evidence from campaigns may suggest reach can make an active difference.

"Our VIP video is by far the most watched on our social media channels," McCormack from German Zero says. "People respond to it very directly. A lot of volunteers of all ages heard about us through that video."

However, some marketing studies have shown that celebrity endorsement of a cause or product can distract from the issue itself, as people only remember the person, not the content of what they were saying.

Choosing the Right Celebrity

Celebrity choice is also very important. Campaigns that use famous faces are often aiming to appeal to members of the public who do not necessarily follow green issues.

For certain campaigns with clear target audiences, choosing a climate scientist or well-known environmentalist rather than a celebrity could be more appealing — Attenborough is a classic example. For others, images and videos involving cute animals may be more likely to get a message heard than attaching a famous face.

"We choose celebrities who have a lifestyle where they are already talking about these issues," says Marchildon from the UN. "You need figures with credibility."

McCormack cites the example of Katharine Hayhoe, an environmental scientist who is also an evangelical Christian. In the southern United States, Hayhoe has become a celebrity in her own right, appealing to an audience that might not normally be interested in the messages of climate scientists.

But as soon as you get a celebrity involved, campaigns also put themselves at risk of the whims of that celebrity. Prince William and younger members of the royal family have come under fire in recent years for alleged hypocrisy for their backing of environmental campaigns while simultaneously using private jets to fly around the world.

But Does It Really Work?

While environmental campaigns hope that endorsement from well-known figures can boost a campaign, there is little research to back this up.

"The biggest finding [from my study] was that we were unable to produce any evidence that shows that celebrity endorsement of environmental causes makes any difference," says Olmedo.

This will come as a blow to many campaigns that have invested time and effort into relationships with celebrity ambassadors. But for many, the personal message that many celebrities offer in videos like that produced by German Zero and campaigns like the Earthshot Prize are what counts.

The research may not prove this conclusively — but if the public believes a person they respect deeply personally cares about an important issue, they are perhaps more likely to care too.

"I personally believe in the power this can have," says Marchildon. "And if having a celebrity involved can get a single 16-year-old future leader thinking about environmentalist issues — that is enough."

Reposted with permission from DW.

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